Name of the Chemotherapeutic Drugs -Anti- tumor antibiotics that are not anthracyclines drugs
- Bleomycin
| BLEOMYCIN |
| Availability: Injection: 15-unit vials, 30-unit vials |
| Administration and Handling: IV/IM Preparation IV: reconstitute 15 U vial in 5 mL & 30 U vial in 10 mL NS to yield 3 U/mL solution IM/SC: reconstitute 15 U vial in 1-5 mL & 30 U vial in 2-10 mL NS/SWI/BWI Do not use dextrose-containing diluents Although may be stable for longer periods, preferably use within 24 hr of reconstitution IV/IM Administration: IM/SC: may cause pain at injection site IV: may be irritant; administer by slow inj over 10 min; pH: 4.5-6.0 Storage: Refrigerate intact vials of powder; stable under refrigeration (2-8°C) |
| Wash hands before and after preparing drug; wear gloves during handling and preparation. For I.M. or subcutaneous use, reconstitute 15-unit vial with 1 to 5 ml and 30-unit vial with 2 to 10 ml of sterile water for injection, normal saline solution for injection, or bacteriostatic water for injection. For I.V. infusion, dissolve contents of 15- or 30-unit vial in 5 or 10 ml, respectively, of normal saline solution for injection. For intrapleural use, dissolve each 60 units in 50 to 100 ml of normal saline solution for injection, then administer through thoracostomy tube. Clamp tube after instilling drug. During next 4 hours, reposition patient from supine to right and left lateral positions several times. Then unclamp tube and restart suction. |
| Premedicate patient with aspirin, as prescribed, to reduce risk of drug fever. Know that cumulative dosages above 400 units should be given with extreme caution because of increased risk of pulmonary toxicity. Know that in patients with lymphoma, anaphylactoid reaction may occur. Such patients should receive 2 units or less for the first two doses. If no reaction occurs, recommended doses may be given. |
| Hodgkin’s lymphoma: Adults: 10 to 20 units/m2 I.V., I.M., or subcutaneously once or twice weekly. After 50% response, maintenance dosage is 1 unit/m2 I.M. or I.V. daily or 5 units/m2 I.M. or I.V. weekly. |
| Malignant pleural effusion; prevention of recurrent pleural effusions: Adults: 60 units dissolved in 50 to 100 mg of normal saline solution, given through thoracostomy tube |
| Squamous cell carcinoma of head, neck, skin, penis, cervix, or vulva; non- Hodgkin’s lymphoma; testicular carcinoma: Adults and children ages 12 and older: 10 to 20 units/m2 I.V., I.M., or subcutaneously once or twice weekly |
Mechanism of Action:
Appears to inhibit DNA synthesis and, to a lesser degree, RNA and protein synthesis. Binds to DNA, causing severing of single DNA strands.
Indications:
- Hodgkin’s lymphoma
- Malignant pleural effusion; prevention of recurrent pleural effusions
- Squamous cell carcinoma of head, neck, skin, penis, cervix, or vulva
- Non- Hodgkin’s lymphoma
- Testicular carcinoma
Off-label uses
- Oesophageal carcinoma
- Hemangioma
- Aids-related Kaposi’s sarcoma
- Osteosarcoma
- Verrucous carcinoma
- Warts
Cautions & Contraindications:
- Hypersensitivity to drug
- Pregnancy or breastfeeding
Use cautiously in:
- Renal or pulmonary impairment
- Elderly patients
- Females of childbearing age.
Metabolism and Half- Life:
- Half-Life: 2 hr
- Protein Bound: 1%
- Metabolism: Unknown
- Metabolites: Bleomycin-iron complex
- Clearance: 35 mL/min
- Excretion: Urine (50-70%)
Drug Interactions:
- Anaesthetics: increased oxygen requirement
- Antineoplastics: increased risk of hematologic and pulmonary toxicity
- Cardiac glycosides: decreased cardiac glycoside blood level
- Cisplatin: decreased bleomycin elimination, increased risk of toxicity
- Fosphenytoin, phenytoin: decreased blood levels of these drugs
- Vinblastine: increased risk of Raynaud’s syndrome
- Uric acid: increased level
Side – Effects:
- CNS: disorientation, weakness, aggressive behaviour
- CV: hypotension, peripheral vasoconstriction
- GI: vomiting, diarrhoea, anorexia, stomatitis
- Hematologic: anaemia, leukopenia, thrombocytopenia
- Hepatic: hepatotoxicity
- Metabolic: hyperuricemia
- Respiratory: dyspnoea, crackles, pulmonary fibrosis, pneumonitis
- Skin: alopecia, erythema, rash, urticaria, vesicles, striae, hyperpigmentation, mucocutaneous toxicity
- Other: fever, chills, weight loss, anaphylactic reaction
Nursing Considerations
- Assess baseline pulmonary function status before initiating therapy; monitor throughout therapy.
- Monitor chest X-rays and assess breath sounds to detect signs of pulmonary toxicity.
- Assess oral cavity for sores, ulcers, pain, and bleeding.
- Monitor infusion site for irritation, burning, and signs of infection.
- Evaluate closely for signs and symptoms of drug fever.
Patient / Family Teaching:
- Tell patient to avoid spicy, hot, or rough foods (may cause GI upset).
- Urge patient to use reliable contraceptive method during therapy.
- Tell patient not to receive vaccinations without consulting prescriber.
- Instruct patient to immediately notify prescriber if breathing difficulties, fever, or chills occur.
- Tell patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.
- Inform patient that drug may cause hair loss, but that hair will grow back after treatment ends.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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